Nutrition and feeding risk identification tool project

Abstract

Since many children with developmental disabilities and/or special health care needs are in fact difficult to feed, unrecognized and unresolved early feeding difficulties could result in less than optimal physical and/or cognitive growth and parent-infant interactions. This project evolved from a concern for the lack of nutritional and feeding support for Wisconsin Birth to Three Programs. A tool and a manual for interpretation of results was developed. The first step is to screen for primary prevention and nutrition/feeding risk identification for all children being served by Birth to Three Programs. This initial step was developed to be used by Birth to Three program personnel, regardless of their nutritional feeding knowledge. The second step is to provide a method for assessment of those children who would potentially benefit from nutrition or feeding intervention within the context of their individual needs, their families and available community resources. Interpretation requires involvement from professionals with nutrition/feeding expertise. This method resulted from collaboration with an interdisciplinary advisory committee including focus groups from four state Birth to Three Programs and pilot testing with two Birth to Three Programs. Preliminary analysis of pilot testing indicated among medical risks the most common diagnosis was prematurity and respiratory disease. The most frequent feeding problems included gagging, constipation, reluctance to eat textures, picky eating and pica. The level of expressed parental concern for nutrition and feeding was 60%, for growth 28%, and behavior at mealtime 52%. The researcher's recommendations for need for second level assessment was significantly higher than Birth to Three staff. Results indicate this is an effective method for screening and assessment and could set the foundation for the third step of referral/intervention. This may include facilitating the provision of anticipatory guidance, coordination of involved service providers or broad-based interdisciplinary intervention. Discrepancies in determination of need for second level assessment suggest the need for systematic training of Early Intervention Staff. This tool could be adapted for use in other settings serving this at-risk population, such as public health departments or perinatal follow-up centers.